Psychology Addict # 19 | Obsessive Compulsive Disorder (OCD) – An Overview

Obsessive Compulsive Disorder

There are many ways through which obsessive compulsive disorder (OCD) manifests itself, with excessive hand-washing being only one kind of compulsion among many. Some people have it so severely that the repetitive ritual of soaping and scrubbing their hands damages the skin. This happens because overwhelming intrusive thoughts flood the individual’s mind, and in an attempt to avoid the thoughts themselves or what they suggest, the individual adopts such routines. For example, Andrew is disturbed by the frightening thought that, unless he ritually washes his hands, a tragedy will happen to his children. Here, Andrew’s instance concisely illustrates what OCD consists of: the repetition of frightening or disgusting thoughts that give rise to compulsive behaviour.

Objective & Subjective Evidence

One of psychology’s top concerns is to obtain comprehensible accounts/profiles. In order to proceed this task, psychologists try to bring together objective and subjective measures, which provides evidence for the individual’s case.

Andrew’s subjective measure, for example, is the unwanted obsessive thoughts that permeate his life. In any psychological case, a subjective report is only accessed through listening to a person’s perspective of what goes in their conscious mind. This is invaluable insight in the understanding of mental ill-health as it represents personal narratives which are not readily available unless the person is willing to share them. As for the objective measures, in this instance, it is the damage to the skin and the number of times Andrew washes his hands; let’s say, within one hour.

Another way of obtaining objective evidence of obsessive thoughts and compulsive behaviour is by means of a PET scan. Research demonstrates patterns of blood flow which are characteristic in certain regions of the brains of individuals with OCD; these are: the orbitofrontal cortex (OFC) - a part of the pre-frontal cortex, and the caudate nucleus; where an increased level of glucose as well as of blood flow takes place. Further still, evidence reveals that there is a positive relationship between the severity of the condition and the level of activity in the aforementioned regions.

As you might have guessed, researchers arrive to these findings through comparing the brains of individuals who do not have OCD with those of people who do.

The caudate nucleus is located deeper within the brain and controls sequences of activities, the switching of actions and, most likely, also of different patterns of thoughts. In OCD they “get stuck”. The PFC is part of the outer layer of the brain and it plays a fundamental role in decision making processes. Psychiatrists suggest that its over activity in OCD brains might be the attempt to try to solve an impossible problem - possibly the getting out of the ‘stuck’ state.

Treatments

SSRIs Drugs – Some patients respond well to this type of drug, while its side effects (dry mouth, dizziness and sleepiness) overwhelm others, who often end up stopping taking them. Prozac is an example of an SSRIs and acts upon the regions of the brain (suffering from OCD) that give rise to the obsessive thoughts that promote the compulsive behaviour.

Behaviour Therapy – In summary, this kind of treatment gradually exposes the person afflicted by the condition to the source of their anxiety, or fear. Let’s use Andrew’s case to exemplify this: His therapist would encourage Andrew not to wash his hands - despite the urge - in order to show him that even if his doesn’t do it, nothing terrible will befall his children.

Brain Lock – This particular kind of treatment follows the slogan ‘it is not me, it is my condition’. Here, patients are guided through the biological basis of ODC; for instance, they are shown brain images of other people with the condition. This helps them to understand that it is a disorder of the *brain*, and in many cases this helps sufferers to perceive the obsessive thoughts differently. In successful situations, the intrusive thoughts are reinterpreted in such ways that the patient doesn’t see them as worthy of a ritual (excessive hand-washing in Andrews’s instance) anymore.

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Behaviour Therapy and Brain Lock Therapy are particularly interesting for psychologists as they demonstrate that brain and behaviour undergo changes even when the intervention is purely psychological. This provides evidence for plasticity - in other words, brain activity can change according to the environment and reality the individual is exposed to.

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In Extreme Cases - A surgical procedure within the implicated area of the PFC where a small amount of tissue is destroyed is the last resort for patients whose OCD becomes incapacitating, and no other kind of treatment has shown considerable results. After the surgical intervention, activity in the caudate nucleus and PFC is considerably reduced, hence alleviating the symptoms and delivering a life free of obsession and compulsion to the patient.

Causes & Diagnosis

Just in case you have made this far and are wondering what causes this disorder, the answer you will get might not be that satisfying. As with various types of mental-illnesses the exact cause is unknown, but it is generally believed that inherited features and the environment contribute for the development of OCD; with symptoms frequently emerging in childhood (in children as young as 5 years-old) and early teens, as reported by over half of the population suffering from the disorder. In addition, it is also thought that abnormality of serotonin neurotransmission in the brain plays a role in it. However, the precise mechanisms are still to be unveiled.

Because OCD is a disorder often talked about in the media and general public, many believe to have it. Still, for someone to be formally diagnosed with it they have to present symptoms that follow the DSM (The Diagnostic Statistical Manual) criteria. For instance, the individual have to show time consuming obsessions and/or compulsions which are not a side effect of legal or illegal drugs, or a symptom of another mental disorder which also triggers obsessive behaviour, as in Trichotillomania where people have the urge to pull out their own hair. These are, of course, just a few examples.

According to anxietycare.org.uk up to 3% of the adult population appears to have OCD in the Western world.

Conclusion:

1 – OCD is the recurrence of unwanted frightening, disgusting thoughts that trigger compulsive behaviour as a means to avoid the thoughts or prevent something bad from happening.
2 – Psychologists look for subjective and objective evidence/measures in order to gain a comprehensive profile.
3 – Patients can be treated through drugs, psychological approaches and undergo surgical intervention.
4 – The exact cause of OCD is not known.
5 – Children aged 5 can present obsessive and compulsive behaviour.
6 – The formal diagnosis follows the DSM criteria.

Reference List :

Baxter, L.R Jr, Scwartz, J.M., Bergman, K.S, Szuba, M.P, Mazziota, J.C, Alazrati, A. et al. (1992) et al. ‘Caudate glucose metabolic rate changes with both drug and behaviour therapy for obsessive compulsive disorder’, Archives of General Psychiatry, vol. 49, pp. 681-9.

Irle, E., Exner, C., Thielen, K., Weninger, G., and Ruther, E., (1998) ‘Obsessive compulsive disorder and ventromedial frontal lesions: clinical and neuropsychological findings’, American Journal of Psychiatry, vol. 55, pp. 255-6.

Schartz, J. (1996) Brain Lock: Free yourself of obsessive compulsive behaviour, London, Harper Collins.

Image source 1, 2, 3 and 4.

[Original content by Abigail Dantes - 2017]

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Dear Steemean, thank you so much for taking the time to read my post 😊